progesterone or estrogen supplements in 2nd pregnancy after PP?

[EquineBeauty]

Hi all! This is sort of a follow up post to my last one. My husband and I are considering IVF for our next and last pregnancy. The docs are saying I’ll need to be on supplemental estrogen and progesterone to make sure the pregnancy “sticks.” They assured me that the amount of hormones are similar to what your body naturally produces in a natural pregnancy in the first 3 months. I’ll need to do these injections for 3 months. I had PP in 2023 with my first and only child. (So far no other diagnoses besides PP.) Regardless if you’ve ever done IVF - did any of you have to take supplemental hormones to keep your pregnancies post PP? Did you notice any changes in mood, etc. if so? Any input is appreciated. Thank you 🙏🏻

[Survivedwithcolor]

I haven’t had any of those injections, but I’ve known people who have and they did say there were some mood effects. Hormones are very powerful things. I’d be surprised if you DIDN’T have any mood effects.

I hope it goes well for you. Do all the self care things you’ve already learned!

[EquineBeauty in reply to Survivedwithcolor]

Thank you Survivedwithcolor! You’re right… I’m sure some changes are to be expected. (I’m of course just worried about it “throwing me over the edge” into an episode) But may be it will be managed and there is always olanzapine that can be taken short term.

[Survivedwithcolor in reply to EquineBeauty]

I try to keep in mind that now that we know better, we have a better chance of coping and catching things early. Now that we have a history, we are less likely to be overlooked by doctors.

[HelenMW Volunteer]

hello there, just thought I would let you Know my experience. Having had PP in 1988 I was very apprehensive for my second and third pregnancies. I looked into the treatment on offer back in 1996 and opted for progesterone therapy. The choice was based on breastfeeding as I couldn’t breast feed on lithium or oestrogen

Straight after delivery I had progesterone suppositories, then injections for about a week after delivery. The regime was planned by Dr Katherina Dalton, endocrinologist, sadly no longer with us.

I was so well and the post natal period was really joyful. My mood was very stable. Prior to PP I had no experience of psychosis, mood swings or depression.

I was absolutely fine both times but there were also other changes including a new relationship, total support, epidural deliveries and no pethedine.

Hope this is helpful in some way

All the very best, Helen x .

[EquineBeauty in reply to HelenMW]

Hello Helen and thank you so much for your response. It is very helpful to hear actually. The theory currently is that it’s the massive drop in progesterone after delivery that contributes to the cause of PP. So perhaps an increase in progesterone may actually be a protective factor? (Like it was likely in your case). Your story gives me hope 🤞🏻🤞🏻🤞🏻

[Rainbow9725 in reply to HelenMW]

Hi Helen, I hope you don't mind my messaging. So glad to hear you pp experience was a lot kinder to you the second time around.

May I ask if the progesterone was only for a week after delivery and then you remained on nothing?

Thank you

N x

[HelenMW Volunteer in reply to Rainbow9725]

Hello Rainbow, I had injections for a few days after delivery and then progesterone suppositories for a few more days. Then nothing at all.

Helen x

[Rainbow9725 in reply to HelenMW]

That's incredible and really encouraging. Thank you for sharing.

N x

[Ellie_at_APP Partner]

Hi EquineBeauty

That's good you're getting some advice about what you can do to stay well if you have a second baby. I know personally that it can be a difficult decision to make, but there are definitely things you can put in place to help you to stay well.

Just in case you haven't seen it already we do have a guide on our website, free to download, about planning a pregnancy if you're at risk of PP. It is written by people with lived experience, as well as specialist perinatal mental health clinicians. There will be a lot of helpful information in there I think.

app-network.org/postpartum-...

I know that it is hard to work out what might have caused the PP, and also what might prevent it happening again. Everyone’s personal experience is each different and tends to involve so many different factors unique to each person, rather than just one thing (such as hormonal changes). We think that hormonal / biological changes are certainly one of these factors.

In my personal experience, in additional to hormonal / biological changes I would also say that lack of sleep and genetic factors (my mum experienced psychosis) were the main factors for me.

The information on our website says what we know so far about what causes PP (under frequently asked questions): app-network.org/what-is-pp/ :

'There are likely to be many factors that lead to an episode of Postpartum Psychosis. We know that genetic factors are important. You are more likely to have Postpartum Psychosis if a close relative has had it. Changes in hormone levels and disrupted sleep patterns may also be involved. Postpartum Psychosis might be more common in women with thyroid problems or pre-eclampsia, but further research is desperately needed to understand the complex interaction of biological, psychological and social factors that are involved. For this reason, we are very keen for people to help us with research into PP - click here to find out more - app-network.org/research/'

We have asked our clinical experts about hormonal supplements to prevent PP, and they say that although hormonal changes may well play a role in PP we need more research to understand this better. Katharina Dalton advocated the use of progesterone therapy for prevention of postpartum mood episodes a number of decades ago, and reported a number of positive case studies. However, there is still a lack of good evidence for it helping and there may in fact be a higher risk of depression in the group treated with progesterone. At present, there is not enough evidence that treatment with oestrogen is beneficial in PP or for maintenance of mood stability after PP. The key clinical guidelines in the UK and around the world (e.g. NICE, SIGN) do not recommend hormone supplements in the treatment or prevention of PP. More research in this area would be very helpful.

I do hope all this information is helpful.

Take care

Ellie

[EquineBeauty in reply to Ellie_at_APP]

Hi Ellie! Thanks so much for your input. I do actually have that guide downloaded (future pregnancies after PP) and have read it extensively. I will read the other link too (possible causes of PP). I’ve read in other articles similar findings - that there is no definitive one known cause of PP but rather a multitude of factors and we are still studying it. I actually did participate in an MGH (Mass General in Boston) study on PP to help future generations of women. In my case I experienced prenatal depression (which I didn’t treat because I was afraid to take anything in pregnancy… in hindsight I should’ve def. taken antidepressants) and then lack of sleep and then I had PP. To my knowledge no family members had any preexisting mental health history. I’m curious Re: your mum - if you’re ok enough to share - did she experience postpartum psychosis like you or a psychotic episode outside of the postpartum period? I have a daughter… so I know she will be at higher risk of having this condition but it’s def. not a guarantee. I think the risk is something like 3% whereas regular population risk is .1% So when she gets older I will have to have a conversation with her about this.

I fully am planning on taking an antipsychotic for a year postpartum after my next birth and even in pregnancy if I have to to help prevent PP. And if anything should happen we have a plan in place which hospital to go to, etc. I have a team of a psychiatrist and therapist watching me.

I was just reaching out on here to see if anyone has taken supplements in pregnancy - not to necessarily prevent PP - but as an addition to help keep the pregnancy and whether they experienced any problems or mood shifts, etc. I do understand that we are all different and there is no guarantee how my body will react but it’s helpful to hear other’s experiences. It’s an interesting finding like you mentioned that some women might experience depression while on progesterone therapy and I might be at risk for that. These are all just options and I will of course discuss all this with my psychiatrist. Thank you so much for all the links and information 🙏🏻😇🤗

[Starlight86]

Hi,

Just wanted to jump on and say that I had IVF for my first pregnancy and was well throughout up until I developed PP when my little boy was 3 months old. The whole IVF process is pretty gruelling so would definitely say to make a plan to look after yourself with whatever self care suits you. I went on to have a frozen embryo transfer a few years later using an embryo from my first cycle and although it ended in miscarriage, I didn’t have any return of PP symptoms. I opted to go back on antidepressants after the miscarriage but mainly as it helped resettle my anxiety after a pretty traumatic time. No one mentioned that I’d want to consider any supplements on top of the normal protocols they use due to my history of PP, they just wanted to ensure that I would be looked after and monitored should I have another baby. Wishing you the best of luck on the next stage of your journey xx

[EquineBeauty in reply to Starlight86]

Oh that’s encouraging! Thanks so much for your reply 😇

So I actually froze my eggs 6 years ago… (and I remained well then) so if we end up having to do IVF - we would use those. (I don’t think I’m up for going through the whole egg retrieval process again.) So if anything we would basically just do the embryo transfer process and hope it “sticks.” If they have to use progesterone and estrogen to supplement the embryo transfer I guess I’ll just have to deal with it and hope to remain well. Your story is encouraging (Re: solid mental health) however I’m so sorry to hear you had a miscarriage. I can imagine that was very hard. I am still on antidepressants now and will probably remain on them throughout the whole process and a couple years after postpartum should I have a successful pregnancy. Thank you again & stay well. 🙏🏻